Carotid-Cavernous Aneurysm

Abstract

The carotid-cavernous aneurysm is a direct communication between the internal carotid artery (i. c. a.) and the cavernous sinus. A rupture of the artery is alone enough to cause a fistula. Such a pathologic communica tion is usually serious but surgical treatment sometimes gives very favourable results. These depend upon accuracy in diagnosis, a thorough knowledge of the extent of the lesion, its anatomical relationships and of the conditions in the cerebral circulation. Arteriography -more than the clinical examination -gives such information. Treatment consists in the mechanical interruption of the afflux of blood to the aneurysm and thus its thrombosis. Clinical pictureThe carotid-cavernous aneurysm is either traumatic or spontaneous, the latter being less frequent. The ratio of the frequency between the traumatic and spontaneous aneurysm is about three to one (DANDY 5). The traumatic aneurysm occurs more often in men, while the spontaneous aneurysm is more common in women.Trauma may consist of a cranial fracture, often involving the base of the middle cranial fossa, or a penetrating wound through the orbit, the nose or the mouth. Sometimes the degree of trauma is very slight: a blow on the skull without even concussion of the brain.A spontaneous aneurysm usually occurs in hypertensive and arteriosclerotic subjects or as a result of a sudden increase of blood pressure due to physical effort, pregnancy, etc. A saccular subclinoidal arterial aneu rysm may rupture into the cavernous sinus causing a fistula. According to CHARCOT the intracavernous tract of the carotid artery is less resistant than all other portions of this vessel.